Wiki Screening colonoscopy with 2 techniques for polyp removal

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Mrsrsnapp

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When a patient has a screening colonoscopy that turns diagnostic and more than 1 polyp is removed by 2 techniques, is the screening diagnosis code supposed to be indicated for both procedure codes? Also should the 33 or PT modifier be with both procedure codes?
 
WIthout seeing the op note, it sounds like you'd code both techniques separately, such as 45385 and 45380 - 59 (or -XS for MCR), if a snare was used on one polyp and a cold biopsy forceps on the other.
The answer of the "33 or PT on both" is a weird one, based on payers payment behaviors. I include the -33 or -PT on both because I haven't seen any documentation stating we should NOT do that. If anyone out there has any such documentation, please share. What's weird is that I get denials back from some payers saying I can't use the -33 or the -PT on the SECOND technique. Again, if anyone has any documentation regarding this, please share. Apparently some payers are processing only the first technique as the 'screening' and not the remaining techniques. There may be 'official' explanantions out there in policies somewhere why they only allow screening mods on the first one but I haven't found any yet so I keep putting the screening mod on all, if applicable.
Hope that helps.
 
nsteinhauser said:
WIthout seeing the op note, it sounds like you'd code both techniques separately, such as 45385 and 45380 - 59 (or -XS for MCR), if a snare was used on one polyp and a cold biopsy forceps on the other.
The answer of the "33 or PT on both" is a weird one, based on payers payment behaviors. I include the -33 or -PT on both because I haven't seen any documentation stating we should NOT do that. If anyone out there has any such documentation, please share. What's weird is that I get denials back from some payers saying I can't use the -33 or the -PT on the SECOND technique. Again, if anyone has any documentation regarding this, please share. Apparently some payers are processing only the first technique as the 'screening' and not the remaining techniques. There may be 'official' explanantions out there in policies somewhere why they only allow screening mods on the first one but I haven't found any yet so I keep putting the screening mod on all, if applicable.
Hope that helps.
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Thank you. I had a claim where the 45385 was paid as diagnostic and the 45380 was denied because it was not preventative even though the primary diagnosis was screening. The polyp that was found by cold forcep biopsy was an inflammatory polyp.
Also, did you happen to see the first part of my question? Should the screening diagnosis go on both procedure codes? For some reason, I've only been putting on one of them. I thought that was what I was taught but now second guessing myself. In my research through the forums, I couldn't find a definitive answer and it looks like it is quite difficult to get paid for both procedures codes no matter how it is coded. Most of my docs only use one technique but some use 2 on almost every colonoscopy with polyps.
 
Yes, the screening diagnosis code should go on both. Thanks, clarkmegan.
I wonder if the payers will only cover ONE preventative screening TECHNIQUE (regardless of modifiers) and that fact isn't mentioned or it's buried in their payment policies.
 
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